Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Jun 1996
[Postoperative mediastinal and subcutaneous emphysema after intubation narcosis].
The case of a 16-year old female is presented who underwent laparoscopy under general anaesthesia and uncomplicated endotracheal intubation. Four hours after uneventful anaesthesia and extubation the patient started vomiting and coughing. Subcutaneous tissue emphysema developed and pneumomediastinum was diagnosed on a chest roentgenogram. ⋯ A tracheal lesion during intubation is the most frequent and thus the most probable cause of air accumulation presenting as pneumomediastinum, pneumothorax or subcutaneous emphysema. As in the present case, increased airway pressure from vomiting or coughing even after a latent period may induce the phenomenon. Very occasional reports on spontaneous pneumomediastinum in young individuals must not detract the circumstances of endotracheal intubation from suspecting an iatrogenic lesion, confirming it by immediate endoscopy and thereupon deciding on conservative or surgical treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Differential indications of non-opioid drugs for postoperative analgesia II. Quantification of the analgesic effect of a combination of metamizol plus diclofenac via patient-controlled analgesia].
In a previous study we investigated the analgesic efficacy of metamizol. After laparoscopic operations, in particular, the reduction of postoperative opioid requirements within the first 24 h after surgery attained clinical relevance (-67%). In the present study we investigated the analgesic efficacy of supplementary diclofenac. ⋯ Combination of metamizol and diclofenac cause a clinically relevant reduction in opioid requirements, in particular after minor orthopaedic surgery and resection of the thyroid gland. There is no need for supplementary diclofenac following laparoscopic surgery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 1996
Review[Prevention and treatment of postoperative nausea and vomiting with 5-HT3-receptor blockers].
Since there continues to be a high incidence of postoperative nausea and vomiting associated with many types of surgery, and the standard antiemetics often do not achieve satisfactory results, there have been attempts to use the 5-HT3 antagonists. This group of substances is relatively new, but has already been used successfully as an antiemetic during chemotherapy. To date, results are on hand for four different 5-HT3 receptor blockers: ondansetron, tropisetron, granisetron and dolasetron. ⋯ The entire group is well tolerated: only occasional and minor side effects have been reported. Even though not all the hopes originally set in the 5-HT3 group of antagonists have been fulfilled, progress has nevertheless been achieved. Especially noteworthy points are a positive cost-effectiveness relationship of these drugs and their appropriate use in case of the proper indications.